Friedman David S, Nordstrom Beth, Mozaffari Essy, Quigley Harry A
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ophthalmology. 2005 Sep;112(9):1494-9. doi: 10.1016/j.ophtha.2005.02.010.
To determine the predictors of treatment for glaucoma and suspect glaucoma in a nationally representative sample of diagnosed persons.
Retrospective cohort study of persons enrolled in a large managed care organization.
Thirty-five thousand seven hundred fifty-four diagnosed suspects, 5265 diagnosed glaucoma persons, and 2633 individuals coded as having cupping of the optic disc.
Linked pharmacy and patient care information were used to examine the predictors of initiating glaucoma treatment in this cohort of persons insured by a single managed care organization. Predictors entered into logistic regression models included diagnostic group (suspect vs. diagnosed), age group, gender, region of the country, provider type at the initial visit (optometrist or ophthalmologist), diagnosis index date divided into 2 periods (1995-1998 and 1999-2001), and health plan enrollment duration after the initial diagnosis.
Occurrence of and factors associated with treatment for glaucoma (argon laser trabeculoplasty [ALT], surgery, or topical ocular hypotensives).
A logistic regression model adjusting for glaucoma status, age, region, clinician seen at initial visit, and index date found that women were less likely to undergo treatment (topical ocular hypotensives, ALT, or surgery) than men (odds ratio, 0.76; 95% confidence interval, 0.71-0.80). Factors other than gender that were associated with greater likelihood of treatment were glaucoma diagnosis, older age, region, and longer follow-up.
We have documented wide variation in treatment among individuals diagnosed as having glaucoma or as glaucoma suspects. Women were 24% less likely to be treated than men, and younger individuals were far less likely to be treated than older ones. Furthermore, treatment varied by region of the country. Understanding the sources of these variations will help in determining how to arrive at better management strategies for individuals with glaucoma and suspect glaucoma.
在全国具有代表性的已确诊患者样本中确定青光眼及疑似青光眼治疗的预测因素。
对参加大型管理式医疗组织的人员进行回顾性队列研究。
35754名确诊的疑似患者、5265名确诊青光眼患者以及2633名被编码为有视盘杯状凹陷的个体。
利用关联的药房和患者护理信息，在由单一管理式医疗组织承保的这一队列人群中研究启动青光眼治疗的预测因素。纳入逻辑回归模型的预测因素包括诊断组（疑似与确诊）、年龄组、性别、国家地区、初次就诊时的医疗服务提供者类型（验光师或眼科医生）、诊断索引日期分为两个时间段（1995 - 1998年和1999 - 2001年）以及初次诊断后的健康计划参保时长。
青光眼治疗（氩激光小梁成形术[ALT]、手术或局部降眼压药物）的发生情况及相关因素。
一个针对青光眼状态、年龄、地区、初次就诊时所见临床医生以及索引日期进行调整的逻辑回归模型发现，女性接受治疗（局部降眼压药物、ALT或手术）的可能性低于男性（比值比，0.76；95%置信区间，0.71 - 0.80）。除性别外，与治疗可能性增加相关的因素包括青光眼诊断、年龄较大、地区以及随访时间较长。
我们记录了被诊断为青光眼或疑似青光眼的个体之间治疗差异很大。女性接受治疗的可能性比男性低24%，且年轻个体接受治疗的可能性远低于年长个体。此外，治疗因国家地区而异。了解这些差异的来源将有助于确定如何为青光眼和疑似青光眼患者制定更好的管理策略。
